Evaluating the Risk of Opioid Abuse in Chronic Pain Patients by Addiction Psychiatry Fellows in an Academic Pain Center

Abstract

Context: Assessing risk of abuse plays an important role in deciding to prescribe opioids for the management of chronic pain.Objective: This study was designed to assess feasibility and effectiveness of opioid prescribing risk assessment by addiction psychiatry fellows during their rotation in a pain clinic in an academic center. Methods:A total of 202 chronic pain patients were evaluated for opioid prescribing risk. Seven addiction psychiatry fellows evaluated opioid prescribing risk in chronic pain patients during their rotation in the pain clinic required as part of their training. One-time patient evaluations for opioid abuse risk were conducted in a once a week ½ day clinic pain clinic. Patient demographics, diagnoses, treatment course, and recommendations were prospectively collected. The main outcome of this study was to determine the number of patients at a high-risk for opioid abuse who were identified as a result of this program. Results:Abnormal toxicology results and high-risk for opioid prescribing was found in 128 patients. Of patients referred for consultation, only 2% were recommended for continued opioid therapy. Conclusion:This feasibility study suggests that supervised addiction psychiatric fellows can conduct opioid prescribing risk assessment effectively. This additional level of assessment was requested by less experienced practitioners, like fellows, while seasoned attending physicians were less inclined to request assistance. Larger multicenter studies are needed to confirm these findings.